NICE food allergy guideline

Food allergy in under 19s: assessment and diagnosis

Introduction

Food allergy is one of the most common allergic disorders and is recognised as a major paediatric problem in western countries. Its prevalence has increased dramatically in recent decades

There is great variation in current practice for allergy care, and there are no agreed treatment pathways or referral criteria. Many people use alternative sources of support instead of NHS services, including non-validated tests and treatments

Key to terms

Food allergy can be classified into IgE-mediated and non-IgE-mediated allergy

IgE-mediated reactions are acute and often have a rapid onset

Non-IgE-mediated reactions are generally characterised by a delayed and non-acute onset

Mixed reactions involve a mixture of both IgE and non-IgE responses

Signs and symptoms of possible food allergy*

The skin

IgE-mediated

pruritus

erythema

acute urticaria (localised or generalised)

acute angioedema (most commonly in the lips and face, and around the eyes)

Non-IgE-mediated

pruritus

erythema

atopic eczema

The gastrointestinal system

IgE-mediated

angioedema of the lips, tongue and palate

oral pruritus

nausea

colicky abdominal pain

vomiting

diarrhoea

Non-IgE-mediated

gastro-oesophageal reflux disease

loose or frequent stools

blood and/or mucus in stools

abdominal pain

infantile colic

food refusal or aversion

constipation

perianal redness

pallor and tiredness

faltering growth plus one or more gastrointestinal symptoms above (with or without significant atopic eczema)

The respiratory system (usually in combination with one or more of the above symptoms and signs)

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.